Hybrid Medical Credentialing Specialist

Everleap Fertility; New Jersey; Hybrid; USD 28,000 - 30,000; Full time

Benefits offered by this job

Medical, Dental, Vision Insurance

Paid Time Off & 8+ Paid Holidays

Company Paid Life Insurance, Long Term

Flexible Spending Accounts

Employee Assistance Program

Retirement 401K Plan

Optional STD, Life & AD&D Buy-up

Job summary

Everleap Fertility in Basking Ridge, NJ is hiring a Medical Credentialing Administrative Assistant to support credentialing tasks for our practitioners across US clinics. This hybrid, full-time role requires attention to detail, ability to manage provider profiles, submit applications, and communicate with health plans.

Candidates with 1 year credentialing experience and strong organizational skills will thrive in a fast-paced, patient-centered environment.

Qualifications

• High school diploma, GED, or suitable equivalent.
• 1 year of credentialing experience with medical staff (preferred).
• Extremely detail oriented and able to prioritize tasks accordingly.
• Knowledge of medical credentialing and privileging procedures and standards (preferred).
• Excellent verbal and written communication skills.

Responsibilities

• Create CAQH profiles for all new providers in our US clinics.
• Identify discrepancies or missing information and conduct follow-ups.
• Update and re-attest each provider profile quarterly and/or as needed.
• Complete and submit initial applications to commercial insurances for participation.
• Notify health plans of provider information/demographical updates and changes as well as practitioner status changes.
• Update demographic information and provide supporting documents to outside stakeholders, such as commercial managed care plans.
• Ensure re-credentialing is completed timely to prevent any lapse in enrollment.
• Respond to health plan provider inquiries.
• Work closely with the billing staff to identify and resolve any denials or authorization issues related to provider credentialing.
• Maintain individual provider files to include up to date information needed to complete commercial payer credentialing and recredentialing.
• Maintain knowledge of current health plan and agency requirements for credentialing providers.

Skills

Credentialing experience

Attention to detail

Verbal and written communication

Knowledge of credentialing procedures

Education

High school diploma, GED, or suitable equivalent

Job description

Everleap Fertility in Basking Ridge, NJ is hiring a Medical Credentialing Administrative Assistant to support credentialing tasks for our practitioners across US clinics. This hybrid, full-time role requires attention to detail, ability to manage provider profiles, submit applications, and communicate with health plans.

Candidates with 1 year credentialing experience and strong organizational skills will thrive in a fast-paced, patient-centered environment.